My Day At Stanford

Today I had an appointment at the Cancer Center at Stanford. I was sold on the place before I walked through the door! They have valet parking that costs less than the parking garage. They will even park oversize vehicles like our RV.

My experience today was so pleasant that it made me believe that the money that the US spends on health care would be just fine if everyone got this kind of service. The registration staff were all dressed professionally and were exceptionally polite and considerate.

My appointment was for 8:30 but they took me at 8:15. A thorough history was done by the Nurse Practitioner and then I saw the Chief of Thoracic Surgery. He examined me and then talked about what needed to happen during the next week.

There are two major possibilities of tumor type (it's almost 100% certain to be tumor). There is large cell and small cell. Small cell is generally 100% related to prior smoking. Surgery is usually not an option. The cancer responds initially to radiation and chemotherapy but the respite tends to be short lived.

Large cell might be amenable to surgery.

So, they need to do some work.

1. has the tumor spread? If so, a cure is not a reasonable hope. In which case, palliation is the treatment of choice...reducing the tumor size if possible, controlling pain, comfort measures. In order to find out, I need to get an MRI of the brain to see if there is tumor there. A few weeks I had a strange kind of optical illusion called a scintillating scotoma (google images shows some of them). Generally these occur before a migraine attack, but I never got a migraine. It makes me suspicious. SO...the MRI of the brain this week.

2. what does the chest look like with respect to activity? Tumors are metabolically active...they use lots of oxygen and sugar. I need to get a PET/CT of the chest. This will be done at Stanford, probably on Monday. It will show activity of lymph glands, chest wall, etc to give them a better idea of which parts are suspicious.

3. I need to know how good my lungs are...can I breathe adequately with the removal of one lung. This evaluation will be done tomorrow in San Luis.

4. What is the tissue? They need to determine the kind of tumor. Although they can reach the tumor through my chest wall, they want to be able to biopsy lymph nodes in the chest to judge the extent of spread. Several lymph nodes appear abnormal right now. However, the surgeon says that the abnormality may only be inflammation and not tumor itself. So to get the tissue, I will have a bronchoscopy...they will be able to slide a tube into my airways and get pieces of the chest tumor and pieces of lymph nodes.  This is scheduled for Wed October 12. I'll be given anesthesia, so I will go through the operation believing that I am on the Nina, Pinta, or Santa Maria. I get to go home the same day.

5. Once all the data is collected, it goes to "tumor board" where 20 cancer specialists including surgeons, pulmonologists, oncologists, radiotherapists, etc. review the case and generate possible treatment plans.

I have told them that I am fortunate enough to have completed most of the essential tasks of my life and that I am much more concerned about pain, suffering, and crappy life quality than I am about a jump into eternity.

I have borrowed the Kubler Ross stages of grief from Wikipedia. When her book came out in the late 60's it made an enormous impression on me. I have been working with hospice for almost 40 years.   Here's her stuff:

The stages, popularly known by the acronym DABDA, include:^[2]

1. Denial — "I feel fine."; "This can't be happening, not to me."
   Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of possessions and individuals that will be left behind after death.
2. Anger — "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?"
   Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy.
3. Bargaining — "I'll do anything for a few more years."; "I will give my life savings if..."
   The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, "I understand I will die, but if I could just do something to buy more time..."
4. Depression — "I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point... What's the point?"; "I miss my loved one, why go on?"
   During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect from things of love and affection. It is not recommended to attempt to cheer up an individual who is in this stage. It is an important time for grieving that must be processed.
5. Acceptance — "It's going to be okay."; "I can't fight it, I may as well prepare for it."
   In this last stage, individuals begins to come to terms with their mortality, or that of a loved one, or other tragic event.

These stages are not like birthdays. People cycle through them and hopefully spend more and more time in stage 5 of Acceptance. That is my goal...stay at Acceptance....that's reality.

I'll repeat here the the last time what I sincerely believe. I am a FORTUNATE man. I am not a victim. I have been given a good life with wonderful family and meaningful, satisfying work. Despite my failures in relationships, I was blessed with three wonderful children, all of whom turned out much better than I deserved. I have great comfort from seeing my boys with women who are beautiful both inside and outside. I have been allowed to see some of my children's children. I was fortunate to run into Jasmine when she was at a weakened state. She took pity on me and came to like me. She is a joy to be with. I have been showered with love.

I am able to face the world with a renewed sense of importance. F*** the Republican candidates. Football is actually more meaningful.

I love hearing from you, getting emails, texts....they make me smile and remind me of my good fortune.